Growing Healthy podcast

Preparing your Perineum for Delivery

Whether it’s your first pregnancy or your third as your due date
approaches you begin to think more and more about what your labour
is going to be like and if there is anything you can do to
prepare…

AP: Dr. Sarah lea is a family doctor specializing in obstetrics
and has specialized training in women’s health. She is also
the mother of three children and therefore is a double expert in
preparing perineums for delivery!!!

SL: That’s right Alicia/Dr. Power. I just had my third baby in
November and the lead up to my delivery was actually the
inspiration for this podcast. I have had difficult deliveries in
the past so wanted to do everything I could in my power to prepare
and make the labour as smooth as possible.

AP: That being said. Let’s dive in. I’m curious what you came
across in your research.

SL: Well, the first think I wondered about was how best to
prepare the perineum (do we define what this is?) to minimize the
risk of tearing and the need for episiotomy (? Define) and stitches
following delivery. I know this is on everyone’s mind regardless of
whether it’s your first delivery or your third!

AP: For sure…I know a few recommendations out there include
perineal massage before labour. What did you find out about
that?

SL: Well Alicia, the literature out there shows that for
women who had never given birth vaginally before reduced the
likelihood of perineal trauma (mostly episiotomy) and ongoing
perineal pain. The evidence wasn’t as clear for women who had had
previous vaginal deliveries but on review of additional studies,
although there is no clear benefit there is definitely no harm In
doing so.

AP: That’s fantastic news! So perhaps we should be letting our
patients know about the benefits of perineal massage and provide
them with some information about how to perform perineal
massage.

SL: Absolutely! There are some great resources available and
perhaps we could post them on our Show Notes.

AP: So what else did you find? I’ve had some women ask me about
shaving in preparation for labour and delivery as a means to reduce
risk of infection. Is this something we should be
recommending?

SL: Interesting you should ask! This is a common myth and
misperception that many women have and believe it or not there are
even studies about this! The general consensus from the literature
is that there is no benefit to shaving or waxing. It doesn’t
decrease the risk of infection, and can actually be associated with
multiple side effects including irritation, itching/burning of the
vulva.

AP: Now that you mention this I think I recall a colleague in
another province saying they actually had a campaign a few years
back called ‘Leave the hair down there’. Just like American Apparel
did!

SL: You’re right. I’d say if a women gets regular bikini waxes
there is no need for her to stop in pregnancy and around the time
of delivery but I’d actually recommend against waxing and
definitely tell patients if it’s not something they routinely do
there is no need for them to get it done!!!

AP: Excellent. So so far, we would recommend perineal massage
for preparation but no neeed to shave or wax.

SL: Yout got it! I’ve also had women ask me about enema or
‘bowel prep’ before labor. And this is an understandable question
as this is something that was routinely done in the past.

AP: Enema – something I think most people wouldn’t look forward
too.

SL: Agreed – and fortunately the evidence agrees too. No need
for routine, or even ‘elective’ enema for that matter!

AP: Something I often have patients asking me is what they can
do to help deliver on time and avoid going overdue. Some patients
ask me about acupuncture. Do you have any thoughts about
this?

SL: It just so happens I do! I have actually gone for
acupuncture for cervical ripening in two of my previous
pregnancies. I also took a look at the literature and it seems that
there is a bit of evidence out there that acupuncture done by
appropriately trained individuals MAY improve cervical readiness
for labour, but the evidence is pretty weak. There hasn’t been a
lot of safety data but what has been reported hasn’t show any
harm.

AP: So it seems the limited research show so far no harm and
possibly some improvement in cervical ripening?

SL: That’s right Alicia. In addition to acupuncture which I
often discuss with patients I’ve had people ask me about castor
oil.

AP: Ah yes, castor oil I understand it can bring labour on but
can also bring on a whole host of undesirable side effects, like
your doctor trying not to vomit on your vagina as I you are
delivery your baby into a puddle of diarrhea…..

SL: You’re right there Alicia. And interestingly the evidence
actually doesn’t show any benefit as there hasn’t been enough
studies done but they have found that women reported more negative
side effects including nausea and diarrhea. A few things you’d
likely not want to experience before going into labour

AP: I’ve had two kids of my own so can definitely agree labour
is hard enough without adding some GI upset in there. What about
‘membrane sweeping or as I like to say “The old stretch and sweep”?
I think this is something most of us at GROW offer our patients
after 38 weeks. Can you comment on how effective this can
be?

SL: Absolutely. For those listeners who don’t know, a membrane
sweep is when your doctor does a pelvic exam and passes a finger
through the cervix and separates the amniotic sac or membranes from
the uterus. There have been lots of studies looking into the
effectiveness and it’s been show to reduce the duration of
pregnancies going post-dates (beyond 41+ weeks), and therefore
avoiding induction because you are overdue.

AP: That’s good to know since I know most of us offer this to
patients. Did they say how many times it has to be done to be
successful? Or if there were any negative side effects?

SL: I’m glad you asked. Membrane sweeping is safe and the most
common side effects are bleeding and pain/cramping following the
procedure, which you will also experience in early labour. And in
terms of how many times, basically you need to do a membrane sweep
on 8 patients to send one into spontaneous labour.

AP: I’d say that’s a pretty decent number given how many
patients we see and offer this to.

SL: I agree, and it’s such a safe and low risk intervention that
I think it’s reasonable to offer to all women as long as they are
aware of the likelihood of going into labour and to expect to
experience some bleeding and pain following.

AP: That’s what I do regularly in my practice, but good to know
I’m following the evidence so I’ll keep it up!

SL: So Alicia, there is a lot more to talk about but I think
we’ve covered a few key topics people would want to know about when
preparing to push, wouldn’t you agree?

AP: I do! SO let’s review. First things first, we should start
recommending perineal massage and will put some resources up on our
show notes. Secondly, we’ll tell our patients no need to shave or
go for a bikini wax and that doing so may actually increase their
risk of infection and that they should ‘keep the hair down
there’!

SL: Totally. Thirdly, if people are hoping to avoid going
overdue we can offer our patients a membrane sweep at term to try
to induce spontaneous labour and avoid women going overdue and we
can also chat about using acupuncture and advise that although more
studies need to be done there is some evidence of benefit when it
comes to cervical ripening but that they should avoid castor oil as
a means to induce labour!

AP: Well, this has been educational and informative for me and
hopefully for our listeners.

SL: Me too! I really enjoyed doing the research for this and
look forward to joining you to chat about another topic
soon!